My vision for the NHS: Pete Calveley, head of Four Seasons healthcare

Pete Calveley belongs to the new breed of private sector senior management determined to break into public services and fully equipped by experience to meet the challenge.

Having been a practising GP for the past 25 years and a primary care trust director, Calveley has gone from gamekeeper to poacher by becoming chief operating officer of Four Seasons Health Care, one of the UK’s largest independent healthcare operators with over 350 care centres and employing more than 21,000 staff.

He speaks highly of the record of West Lincolnshire PCT, where he was medical director, in shifting services out of hospital into the community, anticipating the recommendations of the white paper Our Health, Our Care, Our Say.

The PCT saved a community hospital from closure and moved a range of day care, intermediate care and minor surgical services into it, one of a series of measures providing value for patients and efficiency savings for the PCT. “We were awarded three stars three times running,” he says.

The success of his PCT leaves him wondering about the merits of the latest round of restructuring, which has seen Lincolnshire’s three PCTs combined into one.

He can already see the new mega-PCT’s role as a strategic commissioner conflicting with the role of GPs as practice-based commissioners. Doctors whose commissioning decisions are insufficiently on-message get short shrift.

“Practice-based commissioners are being told by the PCT to think again and come back when they have done so,” Calveley says. “Everybody talks about how services should be provided under the white paper, but nobody’s actually doing it.”

Much of Four Seasons’ business is with local authorities – it has more than 350 care homes for older people throughout the UK and also offers specialised care in mental health, neurodisability and addictions, among other things.

But Calveley is keen to link up with the voluntary sector to offer local authorities and PCTs more imaginative solutions to service users’ needs in the community. He says he is fed up with the “inertia” in the public sector in considering new approaches to care, particularly where the private sector is involved.

In his view, 30% of patients on acute medical wards have no need to be there: chronic conditions such as asthma can be treated just as effectively outside hospital, but the absence of a carer in their own home may be enough to prevent their discharge. He argues that the private sector can provide quality care much more efficiently than the public sector at a fraction of the cost, yet is frequently overlooked because of an institutional bias against the profit motive.

“Health service managers may object to an 11% profit margin, but if the alternative is throwing 50% of service expenditure down the drain it doesn’t make sense,” he insists.

He hopes that the idea of making the NHS independent, mooted early in Gordon Brown’s period as prime minister in waiting, will come to something. It would, he thinks – perhaps optimistically – take the political sensitivity out of the NHS, remove the preoccupation with centrally set targets, and help it get on with the task of providing robust services genuinely tailored to the needs of patients.

“Take McDonald’s – if it’s got a product that it knows works well, that’s what it wants to sell. That’s not the way the NHS works, yet it ought to. There are acknowledged good ways of providing services, so why are people able to do it how they like?”

He adds: “It was a difficult decision to stop being a practising doctor, but I do feel a sense of mission in this new role.”